The public option was initially proposed for the Patient Protection and Affordable Care Act, but was removed after the independent US senator for Connecticut Joe Lieberman threatened a filibuster.
[3][4] The public option was featured in three bills considered by the United States House of Representatives in 2009: the proposed Affordable Health Care for America Act (H.R.
The Clinton campaign stated shortly before the plank was added that as president Clinton would "pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan", while Bernie Sanders applauded the decision to "see that all Americans have the right to choose a public option in their health care exchange, which will lower the cost of healthcare".
[16][17] The call was echoed by President Obama, who in an article for the American Medical Association stated that Congress "should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited.
"[18] In the lead-up to the 2020 presidential election, the public option, "once considered too far-reaching", had become "seen as a more moderate alternative" to proposals like Bernie Sanders' Medicare for All plan.
Supporters also argued (and proposed possible ways) that a government insurance company (public option) could put pressure on private health insurance companies to lower their premium costs and accept more reasonable profit margins, while also encouraging them to create more competitive plans with wider coverage, as well as eventually creating a more competitive, reasonably priced healthcare market across the industry by encouraging more efficient treatments and practices, and finally, eventually generating a large source of non-tax revenue for the government, which could help ease the rate of increasing budgetary deficit.
A public option would be able to offer such competitive options, as they would not be operating as a traditional for-profit business, whereby the main priority is maximization of profits, as is the case of private health insurers- but instead operate much like a non-profit organization, whereby all funds acquired through premiums, minus operating expenses, could be paid out on claims (directly benefiting the policy holder, rather than a disproportionate amount of revenue generated from premiums paid to the insurer by the policy holder serving typical corporate uses, such as multimillion-dollar executive salaries and bonuses,[24] stock dividends,[25] and excess cash flows).
"[33] The final bill, the Patient Protection and Affordable Care Act, included provisions to open health insurance exchanges in each state by October 1, 2013.
[34] An alternative proposal is to subsidize private, non-profit health insurance cooperatives to get them to become large and established enough to possibly provide cost savings[35][36] Democratic politicians such as Howard Dean were critical of abandoning a public option in favor of co-ops, raising questions about the ability of the cooperatives to compete with existing private insurers.
Senator Tom Carper has proposed an "opt-in" system in which state governments choose for themselves whether or not to institute a public plan.
Senator Chuck Schumer has proposed an "opt-out" system in which state governments would initially be part of the network but could choose to avoid offering a public plan.
[43] Both before and after passage in the House, significant controversy surrounded the Stupak–Pitts Amendment, added to the bill to prohibit coverage of abortions – with limited exceptions – in the public option or in any of the health insurance exchange's private plans sold to customers receiving federal subsidies.
Former Congressman and Republican House Minority Whip Eric Cantor has argued that a public plan would compete unfairly with private insurers and drive many of them out of business.
[48] Marcia Angell, M. D., Senior Lecturer in the Department of Social Medicine at Harvard Medical School and former Editor-in-Chief of the New England Journal of Medicine, believes that the result of a public option would be more "under-55's" opting to pay the fine rather than purchase insurance under a public option scenario, instead advocating lowering the Medicare age to 55.
On the News Hour with Jim Lehrer, Williams noted that a public option creates a situation where "you have in essence a player in the industry who is a participant in the market, but also is a regulator and a referee in the game".
A Rasmussen Reports poll taken on August 17–18, 2009, stated that 57% of Americans did not support the current health care bill being considered by Congress that did not include a public option,[51] a change from their findings in July of that year.
[52] An NBC News/Wall Street Journal poll, conducted August 15–17, found that 47% of Americans opposed the idea of a public option and 43% expressed support.
"[60] Between October 28 and November 13, 2009, Democratic senator Dick Durbin's campaign organization polled Americans to rank their support for various forms of the "public option" currently under consideration by Congress for inclusion in the final health care reform bill.
"[66] Conversely, a 2009 IBD/TIPP poll of 1,376 physicians showed that 45% of doctors "would consider leaving or taking early retirement" if Congress passes the health care plan wanted by the White House and Democrats.